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Performance of risk assessment algorithms recommended by the World Falls Guidelines (WFG) to predict fall and fall-related injury among older Chinese community-dwellers
Journal article   Peer reviewed

Performance of risk assessment algorithms recommended by the World Falls Guidelines (WFG) to predict fall and fall-related injury among older Chinese community-dwellers

Weiqiang Li, Min Zhao, Yanhong Fu, David C. Schwebel, Na Zhang, Lei Yang, Jingtao Zhou, Youyou Wu, Tongfei Zhang, Peishan Ning, …
Journal of safety research, Vol.95, pp.338-344
12/2025
DOI: 10.1016/j.jsr.2025.10.018
PMID: 41338789

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Abstract

ntroduction: The World Falls Guidelines (WFG) Task Force published a falls risk stratification algorithm in 2022, but its predictive performance was reported only in Ireland, the United States, the Netherlands, Australia, and Malaysia. Methods: Using a nationally representative dataset, the China Health and Retirement Longitudinal Study (CHARLS), we analyzed data from six follow-up cohort visits (2, 3, 4, 5, 7, 9 years). The Cochran-Armitage trend test examined trends in fall and fall-related injury rate across the WFG algorithm. Multivariable logistic regression models examined associations between the WFG algorithm and fall and fall-related injury incidence rates. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and 95% confidence intervals (95% CIs) were calculated to assess predictive performance of the WFG algorithm. Sensitivity analyses were performed to assess the impact of missing values on principal findings. Results: We included 9,735, 5,377, 4,092, 9,426, 7,776, and 3,355 eligible older adults across the six follow-up time periods, with sample sizes varying due to the study’s dynamic recruitment strategy. Fall risk categorized by WFG algorithm was significantly associated with falls and fall-related injuries at all six follow-up cohorts (p < 0.05). However, its predictive performance for both falls and fall-related injuries was unacceptable, with sensitivity ranging from 20.2% to 32.5% for both outcomes across the six follow-up visits. Sensitivity analyses displayed highly similar results. Conclusion: The WFG algorithm is valuable for predicting future falls and fall-related injuries among older Chinese community-dwellers, but its predictive performance is unacceptable for practical use without considering other contributing factors. Practical Applications: Further methodological modifications of the WFG algorithm are recommended to improve its predictive performance.
 China World fall guidelines algorithm Falls Fall-related injuries Predictive performance Older adults

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